Provider Demographics
NPI:1295087419
Name:LOBERT FRISON, LAUREN HANSCHE (DPT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:HANSCHE
Last Name:LOBERT FRISON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:HANSCHE
Other - Last Name:LOBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:603 W GRAND RIVER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2390
Mailing Address - Country:US
Mailing Address - Phone:810-534-7004
Mailing Address - Fax:810-775-1046
Practice Address - Street 1:603 W GRAND RIVER AVE STE C
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2390
Practice Address - Country:US
Practice Address - Phone:810-534-7004
Practice Address - Fax:810-775-1046
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN69750027Medicare PIN
MIMI6211131Medicare PIN